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Jones K, Taylor SM, Al Afif A. Muscle transposition and free muscle transfer in facial nerve reanimation. Curr Opin Otolaryngol Head Neck Surg 2023:00020840-990000000-00096. [PMID: 37902964 DOI: 10.1097/moo.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
PURPOSE OF REVIEW This review highlights recent advances in facial reanimation surgery particularly related to muscle transposition and free functional muscle transfer (FFMT). RECENT FINDINGS FFMT and muscle transposition are mainstays in the treatment of chronic facial paralysis. Recent literature evaluates single versus dual innervated FFMT, reanimation of the periocular region and lower lip depressors, and indications for such methods over gold standard FFMT techniques. New donor sites for muscle transposition and FFMT are also described. SUMMARY Gracilis FFMT (GFMT) continues to be the gold standard in dynamic facial reanimation for patients with chronic facial paralysis. Muscle transposition should be considered in older patients, those medically unfit for long operative procedures, and individuals who prefer more immediate results. With respect to FFMT, described nerve coaptation patterns, surgical stages, and donor muscle choice vary. Standardization of data reporting and outcome measures is needed in future studies.
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Affiliation(s)
- Kia Jones
- Department of Head and Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - S Mark Taylor
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ayham Al Afif
- Department of Head and Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Frias V, Al Afif A, Markiewicz MR. Immediate Free Fibula Flap After Maxillectomy With Simultaneous Full-arch Dental Implant-Supported Prosthetic Rehabilitation of the Midface and Mandible: The "Super Reconstruction Concept". J Craniofac Surg 2023; 34:2153-2156. [PMID: 37643124 DOI: 10.1097/scs.0000000000009695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Immediate reconstruction and dental rehabilitation for ablative defects of the head and neck in one surgery is now a commonly used technique among reconstructive surgeons. Often patients are edentulous or partially edentulous in the jaw opposing that with pathology. In this case, only rehabilitating the dental arch affected by pathology would not render the patient with a functional occlusion. We introduce the "super reconstruction" concept which includes not only rehabilitating the dental arch affected by pathology but also the opposing arch, giving the patient a fully functional occlusion at the time of ablative surgery. This concept is described through a case of a patient with a T4aN0M0 squamous cell carcinoma of the maxilla who underwent total maxillectomy, immediate fibula flap reconstruction of the maxilla with, and full arch dental implant placement into the maxilla and opposing mandible with prosthetic rehabilitation.
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Affiliation(s)
- Vladimir Frias
- Department of Oral Oncology, Roswell Park Comprehensive Cancer Center
| | - Ayham Al Afif
- Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center
| | - Michael R Markiewicz
- Department of Head & Neck/Plastic & Reconstructive Surgery, Roswell Park Comprehensive Cancer Center
- Department of Oral and Maxillofacial Surgery, Associate Dean for Hospital Affairs, School of Dental Medicine, University at Buffalo
- Department of Neurosurgery, Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences
- Craniofacial Center of Western New York, John Oishei Children's Hospital, Buffalo, NY
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Su YXR, Ganry L, Ozturk C, Lohman R, Al Afif A, McSpadden R, Frias V, Pu JJ. Fibula Flap Reconstruction for the Mandible: Why It Is Still the Workhorse? Atlas Oral Maxillofac Surg Clin North Am 2023; 31:121-127. [PMID: 37500195 DOI: 10.1016/j.cxom.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Affiliation(s)
- Yu-Xiong Richard Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China.
| | - Laurent Ganry
- Department of Head and Neck Surgery, Gustave Roussy Cancer Campus, 94800 Villejuif, France
| | - Can Ozturk
- Department of Head & Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Rob Lohman
- Department of Head & Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ayham Al Afif
- Department of Head & Neck, Plastic and Reconstructive Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ryan McSpadden
- Department of Dentistry, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA; Department of Maxillofacial Prosthetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Vladimir Frias
- Department of Dentistry, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA; Department of Maxillofacial Prosthetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jane Jingya Pu
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
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Al Afif A, Rigby MH, MacKay C, Brown TF, Phillips TJ, Khan U, Trites JRB, Corsten M, Taylor SM. Injection laryngoplasty during transoral laser microsurgery for early glottic cancer: a randomized controlled trial. J Otolaryngol Head Neck Surg 2022; 51:12. [PMID: 35317850 PMCID: PMC8939150 DOI: 10.1186/s40463-022-00564-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transoral laser microsurgery is widely used for treating T1/T2 glottic cancers. Hyaluronic acid (HA) is commonly used in vocal cord augmentation. We investigated the impact of intra-operative injection laryngoplasty on voice outcomes in early glottic cancer. METHODS Twenty patients were randomized to the treatment group receiving HA injection to the vocal cord contralateral to the lesion; or the control group, receiving no injection. Patients had a Voice Handicap Index-10 (VHI-10) questionnaire and a Maximum Phonation Time (MPT) measurement preoperatively and at 3, 12 and 24 months post-operatively. Mean change in VHI-10 and MPT, compared to baseline and between time points, were compared. Survival estimates were calculated. RESULTS Mean VHI-10 scores improved over time amongst all patients. There were no changes in mean VHI-10 from pre-operative values to 3, 12 or 24 months post-operatively. There were no significant differences when comparing various timepoints between groups. There were no significant changes in MPT amongst the groups, or the time-points compared. Two-year overall survival was 91.7%; disease free survival was 80.9%; no difference in recurrence free survival was seen between the groups. CONCLUSION Subjective voice scores improved over time in both groups; there were no improvements in VHI-10 or MPT scores in the injection group, over control, at any time points. We saw no significant impact for intra-operative HA injection laryngoplasty on subjective or objective voice outcomes following surgery for early glottic cancers.
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Affiliation(s)
- Ayham Al Afif
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada. .,University of Alabama at Birmingham, 1155 Faculty Office Tower, 510 20th Street South, Birmingham, AL, 35233, USA.
| | - Matthew H Rigby
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Colin MacKay
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Timothy F Brown
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Timothy J Phillips
- Department of Surgery, Queen's University, Victory 3, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada
| | - Usman Khan
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Jonathan R B Trites
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Martin Corsten
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - S Mark Taylor
- Queen Elizabeth II Health Sciences Centre, 3rd Floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
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Khan U, Al Afif A, Aldaihani A, MacKay C, Rigby MH, Rajaraman M, Imran SA, Bullock MJ, Taylor SM, Trites JRB, Hart RD. Patient and tumor factors contributing to distant metastasis in well-differentiated thyroid cancer: a retrospective cohort study. J Otolaryngol Head Neck Surg 2020; 49:78. [PMID: 33198797 PMCID: PMC7667857 DOI: 10.1186/s40463-020-00469-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Distant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC). There is limited information available to clinicians regarding pathological features that confer a higher risk of distant metastasis (DM). This study aimed to identify patient and tumor factors that were associated with the development of DM over time in patients with WDTC. METHODS A retrospective cohort analysis of patients with WDTC (n = 584) at our institution was performed between 2007 and 2017. A total of 39 patients with DM and 529 patients with no DM (NDM) were included. Patient demographics, tumor characteristics and patient survival were compared between the DM and NDM groups using a univariate analysis. Multivariate Cox-proportional hazards model was used to evaluate the risk of developing distant metastasis over time. Kaplan-Meier analysis was used to compare survival between the DM and NDM groups. RESULTS Distant metastasis had a substantial impact on disease-specific survival (DSS) at 5 and 10-years in the DM group; 71.0% (SE 8.4%) and 46.9% (SE 11.6%) respectively, compared to 100% survival in the NDM group (p < 0.001). The DM group had significantly higher proportions of males, lymphovascular invasion (LVI), nodal metastasis (NM), large tumor size (TS), extrathyroidal extension (ETE), positive resection margins, multifocality, follicular thyroid cancer (FTC), tall cell variant of papillary thyroid cancer (PTC), and Hurthle cell carcinoma (HCC), when compared to the NDM group (p < 0.05). A TS ≥ 2 cm (Hazard Ratio (HR) 1.370), NM (HR 3.806) and FTC (HR 7.068) were associated with a significantly increased hazard of developing distant metastasis in patients with WDTC. CONCLUSIONS TS ≥ 2 cm, NM and FTC are associated with a significantly increased propensity for developing DM in our cohort of WDTC patients.
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Affiliation(s)
- Usman Khan
- Faculty of Medicine, Dalhousie University, 1459 Oxford Street, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Ayham Al Afif
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Dickson Building, QEII Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Abdullah Aldaihani
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Dickson Building, QEII Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Colin MacKay
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Dickson Building, QEII Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Matthew H Rigby
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Dickson Building, QEII Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Murali Rajaraman
- Department of Radiation Oncology, Dalhousie University, Nova Scotia Cancer Centre, 5820 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Syed Ali Imran
- Division of Endocrinology & Metabolism, Department of Medicine, Dalhousie University, 1276 South Park Street, Suite 7-North-048 Victoria Building, Halifax, NS, B3H 2Y9, Canada
| | - Martin J Bullock
- Department of Pathology, Dalhousie University, DJ Mackenzie Building, 5788 University Avenue, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Dickson Building, QEII Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Jonathan R B Trites
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Dickson Building, QEII Health Sciences Centre, 5820 University Avenue, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Robert D Hart
- Division of Otolaryngology - Head and Neck Surgery, University of Calgary, ENT Clinic, 1820 Richmond Road SW, Calgary, AB, T2T 5C7, Canada
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AlYousef MK, Al-Sayed AA, Al Afif A, Alamoudi U, LeBlanc JM, LeBlanc R. A pain in the neck: Salmonella spp. as an unusual cause of a thyroid abscess. A case report and review of the literature. BMC Infect Dis 2020; 20:436. [PMID: 32571225 PMCID: PMC7310241 DOI: 10.1186/s12879-020-05161-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Thyroid gland infections are rare. Their incidence is estimated to be less than 1% in immunocompromised hosts. Most common pathogens isolated are Gram positive aerobic cocci. Infections with Gram negative facultative aerobes such as Salmonella are rare. Case presentation A 55-year-old female with type II diabetes mellitus and a history of a colloid right thyroid lobe nodule presented with neck pain and fever. She was found to have a thyroid abscess 2 weeks following a non-specific diarrheal illness. A needle aspiration for symptomatic and diagnostic purposes was performed. Cultures grew Salmonella enterica serotype Heidelberg. She was treated with a 12-week course of oral antibiotics and serial aspiration. Conclusion A thyroid abscess is a rare occurrence; however, a high index of suspicion is required to make the diagnosis. The management is directed at minimizing morbidity. The mainstay treatment is medical, but surgery is sometimes necessary to achieve adequate source control, particularly when complications arise.
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Affiliation(s)
- Maha K AlYousef
- School of Education, Acadia University, 22 Crowell Drive, Wolfville, NS, B4P 2R6, Canada
| | - Ahmed A Al-Sayed
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada. .,Department of Otolaryngology Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia.
| | - Ayham Al Afif
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada
| | - Uthman Alamoudi
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada.,Department of Otolaryngology Head and Neck Surgery, Hail University, Hail, Saudi Arabia
| | - Jaclyn M LeBlanc
- Division of Infectious Disease, Department of Internal Medicine, Dalhousie University, 5780 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Robin LeBlanc
- Division of Otolaryngology Head and Neck Surgery, Department of Surgery, Dalhousie University, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada
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Ubayasiri K, Al Afif A, Herruer J, Taylor SM. Transoral microscopic cautery-assisted laser tonsillectomy/tongue base resection (TOMCAT). Clin Otolaryngol 2019; 45:304-306. [PMID: 31797526 DOI: 10.1111/coa.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Kishan Ubayasiri
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Ayham Al Afif
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Jasmijn Herruer
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - S Mark Taylor
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
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Allen L, Al Afif A, Rigby MH, Bullock MJ, Trites J, Taylor SM, Hart RD. The role of repeat fine needle aspiration in managing indeterminate thyroid nodules. J Otolaryngol Head Neck Surg 2019; 48:16. [PMID: 30894222 PMCID: PMC6425601 DOI: 10.1186/s40463-019-0338-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 03/05/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The Bethesda System is the most widely used for reporting fine needle aspiration (FNA) cytology. It recommends a repeat FNA (rFNA) when initial results are category I or III. It is unclear how often rFNA provides additional diagnostic information. We sought to investigate its utility at our institution. METHODS A retrospective chart review was performed of patients who had a category I or III FNA result and underwent rFNA of the same thyroid nodule between 2013 and 2015 at the QE II Health Sciences Centre in Nova Scotia, Canada. Results of initial FNA and ultrasound characteristics, rFNA, demographic data, surgical details, and pathology were collected. RESULTS A total of 237 patients (474 thyroid FNAs) were included. Most initial FNAs were category I (82%), the remainder category III (18%). rFNA yielded a different category 60% of the time. However, 60% remained category I or III. rFNA results of benign or malignant were found in 40% of cases; 1% were SFN/SFM. Twenty-seven percent of patients had surgery after rFNA; of those 68% had category I or III rFNA results. Of all nodules that underwent surgery, 46% were malignant, including 32% with category I rFNA results, and 42% category III. CONCLUSIONS rFNA for category I and III nodules provided a definitive diagnosis in only 40% of cases, which is important for patient counseling. Malignancy rates at our centre were higher for these categories than predicted by Bethesda. Clinical management should consider institution specific malignancy rates, patient factors, and ultrasound findings.
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Affiliation(s)
- Laura Allen
- Faculty of Medicine, Dalhousie University, 1459 Oxford Street, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Ayham Al Afif
- Dalhousie University Division of Otolaryngology - Head & Neck Surgery, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Matthew H Rigby
- Dalhousie University Division of Otolaryngology - Head & Neck Surgery, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Martin J Bullock
- Department of Pathology, Dalhousie University, Sir Charles Tupper Medical Building, Room 11B, 5850 College Street, PO Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Jonathan Trites
- Dalhousie University Division of Otolaryngology - Head & Neck Surgery, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - S Mark Taylor
- Dalhousie University Division of Otolaryngology - Head & Neck Surgery, QEII Health Sciences Centre, 3rd floor Dickson Building, 5820 University Avenue, Halifax, NS, B3H 1Y9, Canada
| | - Robert D Hart
- Department of Surgery, Section of Otolaryngology - Head and Neck Surgery, University of Calgary, 1007 North Tower, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB, T2N 2T9, Canada.
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Al Afif A, Farmer R, Bance M. Outcomes of transmastoid resurfacing for superior canal dehiscence using a cartilage overlay technique. Laryngoscope 2019; 129:2164-2169. [DOI: 10.1002/lary.27789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ayham Al Afif
- Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryDalhousie University Halifax Nova Scotia
| | - Robert Farmer
- Department of Family PracticeUniversity of British Columbia Vancouver British Columbia Canada
| | - Manohar Bance
- University of CambridgeDepartment of Clinical Neurosciences Cambridge United Kingdom
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Abstract
BACKGROUND Papillary thyroid cancer (PTC) is the most common thyroid malignancy, with a strong predilection for lymph node metastasis, most commonly to the central neck compartment (level VI). Few studies have evaluated lymph node metastasis in multifocal PTC, and the role of level VI dissection in the management of PTC remains controversial. This retrospective analysis evaluated the rate of level VI lymph node positivity in multifocal PTC, as compared with unifocal disease, in order to inform surgical decision making better. METHODS Patients with PTC who underwent total or hemi-thyroidectomy plus level VI lymph node dissection at the authors' institution between January 2008 and June 2014 were included (N=227). The number and laterality of PTC foci, lymphovascular invasion (LVI), extrathyroidal extension (ETE), and positive/total number of level VI lymph nodes were recorded. Fisher's exact test was used to determine univariate associations, and multivariate analysis was done by logistical regression. RESULTS There was an association between the number of PTC foci and level VI node positivity (p<0.001), with an odds ratio (OR) of 2.355 in patients with three or more tumor foci (p=0.026). The OR for central neck metastasis was 1.088 with each additional focus of PTC (p=0.018). The risk of level VI node positivity in the presence of one or two foci was only 19%, with no appreciable difference between one and two foci. This risk increased in the presence of between three and nine foci (38%), and 10 or more foci (88%). Level VI node positivity was associated with ETE (p<0.001), LVI (p<0.001), and size of the largest focus (p<0.001). There was no association between level VI lymph node positivity and male sex (p=0.089), bilaterality (p=0.276), or age (p=0.076). CONCLUSIONS There is a significant association between multifocal PTC and level VI lymph node positivity, increasing proportionally with the number of foci. These findings recognize multifocality as a sign of tumor aggressiveness, as evidenced by a higher propensity for lymph node metastasis.
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Affiliation(s)
- Ayham Al Afif
- 1 Faculty of Medicine, Dalhousie University , Halifax, Canada
| | - Blair A Williams
- 2 Division of Otolaryngology-Head and Neck Surgery, Dalhousie University , Halifax, Canada
| | - Mathew H Rigby
- 2 Division of Otolaryngology-Head and Neck Surgery, Dalhousie University , Halifax, Canada
| | - Martin J Bullock
- 3 Department of Pathology, Dalhousie University , Halifax, Canada
| | - S Mark Taylor
- 2 Division of Otolaryngology-Head and Neck Surgery, Dalhousie University , Halifax, Canada
| | - Jonathan Trites
- 2 Division of Otolaryngology-Head and Neck Surgery, Dalhousie University , Halifax, Canada
| | - Robert D Hart
- 2 Division of Otolaryngology-Head and Neck Surgery, Dalhousie University , Halifax, Canada
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